In The Court Of Appeals Of The State Of Alaska Docketing Statement C For Use In Expedited Appeals Under Appellate Rule 216 And Juvenile Appeals Under Appellate Rule 219 Page 2

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7. PEREMPTORY CHALLENGE APPEAL
a. Trial Court Case No.
b. Judge Who is the Subject of Challenge
c. Date Order or Judgment Distributed
f. Pending Charges in Alaska
e. Pending Charges in Trial Court
NO
YES
8. JUVENILE APPEAL (DOB:
)
a. Superior Court Case No.
b. Superior Court Judge
c. Date Order Distributed
d. Juvenile Delinquency Appeal
e. Juvenile Waiver Appeal.
List Underlying Charges(s)
Nature of Appeal
adjudication only
disposition only
adjudication and disposition
Part of disposition being appealed
Institutional Commitment
Probation
Other. Specify
.
9. ATTACHMENTS
The following items are submitted with this form:
a.
A copy of the final order or judgment from which the appeal is taken.
c.
A $200 filing fee or
a motion to appeal at public expense (financial statement affidavit form must be included).
a motion to waive filing fee (financial statement affidavit form must be included).
no filing fee is required because appellant is
represented by court-appointed counsel,
the state or an agency thereof.
d.
For juvenile appeal only: A designation of electronic recording
submitted.
not submitted (no electronic recording being requested).
motion to extend submitted.
Date Signature
of Appellant or Appellant’s Attorney
10. ATTORNEY INFORMATION*
a. Name
b. Bar Number
c. Attorney Mailing Address
d. Telephone
e. Fax
City
State
Zip Code
f. Firm/Agency
*Complete this box only if the attorney who signs form is not the attorney named in box 2, 3, or 4.
CERTIFICATE OF SERVICE
FILING INSTRUCTIONS
I certify that on
a copy of the notice of appeal, this
File original docketing
docketing statement, and all attachments (except filing fee) were
statement and notice of
mailed
delivered
to All parties in the trial court (listed)
appeal with all attach-
ments listed in #9 and
ONE copy of ALL except
filing fee.
Signature:
COA-C-2 (rev. 8/15)

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